Care Home: Highgate Nursing Home (The)

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What the care home does well Potential residents are comprehensively assessed by skilled staff prior to their moving in. Individual plans that address a range social, personal and healthcare needs are developed with residents. These are regularly reviewed and any identified risks are assessed. The plans we saw were person centred and included life story work. The home maintains a record of healthcare appointments attended by residents, and their outcome. Sound medication administration practises have been developed and implemented. Residents receiving end of life care are supported by trained staff who provide sensitive and skilled care. Residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Meals are nutritious, well balanced and well prepared. The home is able to provide male or female carers in accordance with residents wishes. Whilst providing personal care residents autonomy and dignity are promoted, and their preferences for how their care is delivered are respected. People who use the service feel comfortable and secure in sharing any concerns or worries they have with staff. The home has developed a complaints procedure and appropriately investigates, records and takes suitable action if any complaints are received. The premises are very comfortable and extremely well maintained. The accommodation has been adapted to meet the needs of people who use the service. The service has developed and implemented sound recruitment practises, and people who use the service benefit from well trained staff. The manager is highly competent and skilled, and the home has a relaxed, open atmosphere. The home maintains a range of health and safety records as required by legislation. What has improved since the last inspection? No requirements were made as a result of the previous inspection. What the care home could do better: As a result of this inspection, one requirement and one good practise recommendation are made. The home must ensure that all individual plans are reviewed at least monthly, and should ensure that meals reflect the cultural heritage and preferences of residents. Key inspection report Care homes for older people Name: Address: Highgate Nursing Home (The) Northgate House 12 Hornsey Lane London N6 5LX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lea Alexander     Date: 1 6 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Highgate Nursing Home (The) Northgate House 12 Hornsey Lane London N6 5LX 02072813511 02072818412 quinnc@bupa.com www.bupa.co.uk BUPA Care Homes (GL) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Carol Ann Quinn Type of registration: Number of places registered: care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: For the provision of general nursing care for 34 people aged 60 years and over, some of whom may have dementia 1.2) 17 continuing care beds for people of all ages and 4 pallative care beds. The Staffing Notice Date of last inspection Brief description of the care home The Highgate Nursing Home provides accommodation, personal, social, and nursing care, for up to 55 people. It is registered to provide this care to both younger adults (18 to 64) and older people (aged 65 plus). The home is managed by BUPA, a Provident Society with many other similar homes across the UK. Care Homes for Older People Page 4 of 27 Over 65 34 0 0 0 17 4 Brief description of the care home The home is situated just off Highgate Hill, in North London, and on several local bus routes. Archway tube station is a short bus ride away, as are the shops of Highgate Village. Access to local amenities by foot or wheelchair would be difficult for anyone with any mobility problems due to the steepness of the hill. There is parking to the front of the home. The accommodation is over four floors, fully wheelchair accessible, with a lift and stairs to all floors. Most bedrooms have ensuite showers, with all having toilets and hand basins. There are specialist communal bathrooms on each floor for those who prefer a bath. There are communal dinning and lounge areas on each floor, but people can also choose to eat in their rooms if they wish. Bedrooms are of varying shapes and sizes, and efforts are made to match people, and their needs, to available rooms. There is a spacious, and well designed and stocked, garden to the rear of the home. People living in the home are a mix of short and longer stay, and funding themselves or funded by social services and health. In some cases a combination of funding is agreed, with the person, or their relatives, paying a `top up? fee, where charges are above the level that health and social services will agree to fund. Charges are #1,210 per week and #220 per day for short stays. Additional charges are agreed with health where a higher level than usual of nursing care is needed. Extras charged are for hairdressing, chiropody, physiotherapy, phone, dry cleaning, newspapers, and private prescriptions. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: One Inspector carried out this inspection over the course of a day. We visited the home and spoke with residents, the manager and deputy manager. We also spoke with visiting family members and the local GP. In addition we examined a range of records relating to the running of the home including residents personal files, staff personnel files and health and safety records. The home has 52 rooms, some of which are doubles. At the time of this inspection their were 40 residents. Of these, 9 residents were younger people with high dependency needs, and 31 were frail, elderly people. We spoke privately with four people who use the service, and with two visiting relatives. They told us that staff were very good, and that they were reliable and approachable. Residents and relatives spoke very positively about the manager and deputy manager and again commented how approachable they were. Care Homes for Older People Page 6 of 27 We also spoke with the local GP who was visiting the home. They commented that excellent care was provided, and said that it would be hard to find a better care home. They also commented that staff were very caring and that the manager is extremely dedicated. We received seven completed feedback surveys from people who use the service. They told us that they were extremely satisfied with the service that they receive, and commented particularly on how helpful staff were and how approachable the manager and deputy manager are. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 27 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All new residents receive a comprehensive needs assessment before admission. This is carried out by staff with skill and sensitivity. Evidence: We examined the personal file of one resident who had recently moved into the home. This evidenced that they had been comprehensively assessed prior to their moving in. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive effective personal and health care support using a person centred approach that promotes autonomy, dignity and respect. The home is sensitive and skilled in caring for residents who are approaching the end of their lives. Evidence: We examined the personal files of four people who use the service. These evidenced that for each a clearly laid out individual plan had been developed that addressed a range of health, personal and social care needs. These plans are generally reviewed monthly, however we did note that for two residents recent reviews had been bi monthly. The plans that we saw contained evidence of life story work and person centred planning. For each of the residents we case tracked a risk assessment that addressed falls had been completed. Discussion with the manager and residents and sampling of personal files evidenced that all residents are regularly assessed and monitored for pressure Care Homes for Older People Page 12 of 27 Evidence: sores. All residents identified at risk of pressure sores are placed on specialist mattresses. At the time of this inspection we case tracked two residents who were recovering from pressure sores. One had been admitted to the home with a sore, and another had been returned from hospital with a sore. We examined the personal files of these residents and noted that since admission to the home the pressure areas had improved and were healing. With residents permission the home used photographs to monitor the treatment and progress of these pressure sores. For each of the residents we case tracked there was a record of medical appointments along with their outcome. We examined the available medication and Medication Administration Record (MAR) for one person who uses the service. All of the available medications were listed on the MAR sheet. The MAR sheet was appropriately completed and in good order. Some medications were as required (PRN) medications, and we found that there was clear information alongside the MAR sheet that described the circumstances in which these should be administered. The resident we case tracked was also taking some controlled medications. The home records the receipt and administration of these drugs in its controlled drugs register, and also keeps these medicinces securely in a seperate cabinet. We reviewed with the deputy manager the system for auditing medication and accounting for all medicines received within the home. We found this system to be robust and accurate. The home has a mix or male and female carers and can provide a carer of either gender to assist residents with personal care in accordance with their preference. The residents we spoke to told us that staff promoted their dignity and respect whilst assisting with personal care, and that staff listened to and responded to their preferences with regards to personal care. The residents we spoke with told us that they chose their own clothes and hairstyles. Residents appearance was individual and reflected their personality. The home has recently achieved the Gold Standard Framework for end of life care. The home has close links with the local palliative care team, and we noted that the palliative care nurse was on site during our visit. The home will discuss the end of life care wishes and needs for all palliative care referrals to the home in a way and at a time of the residents choosing. A similiar approach is taken with older residents. One resident we spoke with was receiving palliative care. The resident told us how the Care Homes for Older People Page 13 of 27 Evidence: homes manager and deputy manager had worked with them to establish how they would like to spend their remaining time and their care wishes. The resident also commented how supportive the manager and deputy manager had been. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The service understands and promotes the importance of respect, autonomy and dignity for residents. Meals are nutritious, well balanced and well prepared. Evidence: The home employs one full time and one part time activities co-ordinator. A range of group activities are available in the home including drama therapy, maintaining mobility, flower arranging, music therapy, arts and crafts, movie afternoons, reminiscence group, gardening group and a visiting dog. In addition to the organised groups the co-ordinators also spend 1:1 time with residents. These sessions can include the use of memory boxes, or maintaining daily living skills such as baking. During our visit to the home we observed the activities co-ordinator facilitate a bingo afternoon for residents. There is also a visiting hairdresser and the home has a dedicated salon area on site. The residents we spoke to told us that they enjoyed the range of activities on offer and joined in when they wanted to. Care Homes for Older People Page 15 of 27 Evidence: Residents are supported to maintain contact with their families, who are encouraged to visit at the home. The home also organises residents and relatives social evenings. The residents we spoke to told us that their visitors were welcomed and made to feel comfortable. The visitors we spoke to agreed with this. Sampling of individual plans and discussion with residents evidenced that residents rights to make decisions about their lives are reflected in their plans and respected in their day to day lives. Residents told us that the food was very good, and that they enjoyed the meals provided. One resident did comment that they would like more dishes that reflect their cultural background. This resident also commented that they had not yet fedback this back to the home, but were happy for us to do so on their behalf. We looked at the homes menu and found that a choice of varied, balanced and nutritious meals was provided. Residents can choose to eat their meals in the large dining area, in the lounge area or in their rooms. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents, relatives and professionals say that they are extremely satisfied with the service provided. The home has an open culture where individuals feel safe and supported to share any concerns. The ethos of the home is to welcome complaints and suggestions and to use these positively. Evidence: One resident we spoke with told us that they had made a complaint in the past, and that the manager or deputy always dealt with any concerns very promptly, usually on the same day. The resident told us that they were very satisfied with the way their concern had been dealt with. The other residents we spoke to told us that they had not had reason to complain, but that they were aware of the homes complaints procedure and felt comfortable approaching staff if they had any concerns. We looked at the homes complaints log. This contained a record of each complaint received along with the details of the investigation and its outcome. We formed the view that complaints were appropriately investigated, and noted that the majority were not upheld. Where appropriate the home had notified the Commission of complaints received. We had received a number of notifications from the home since the last inspection Care Homes for Older People Page 17 of 27 Evidence: relating to safeguarding matters. We noted that the home had taken appropriate action to inform local Social Services and carried out appropriate investigations. We were satisfied that the home takes appropriate steps to safeguard residents. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is extremely comfortable and well maintained. It is designed to meet a range of residents needs. Evidence: As part of our visit we toured the homes premises. The home is split over four levels. Each floor has a communal lounge, kitchenette, sluice, shared bathrooms, a treatment room and residents bedrooms. Access to each floor can be obtained by the stairs or through either of the homes two lifts. On the ground floor there is a large dining room that can be used by all residents, as well as seperate physiotherapy rooms and a hairdressing salon. The homes kitchen, staff room and administration offices are also located on the ground floor. There is also a communal library and two conservatory areas that all residents can access. Each resident has their own bedroom, and the ones we saw had been personalised to reflect the residents personality and interests. The home was redecorated throughout in 2009. We found the premises to be suitable, safe and maintained to an extremely high standard. During our visit we found the premises to clean, hygenic and free from offenisve odours. The residents we spoke to told us that the home was always very clean and Care Homes for Older People Page 19 of 27 Evidence: well maintained. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has developed sound recruitment practises that safeguard people who use the service. The service ensures that all staff receive relevant training. Evidence: The home is split over four floors. Three shifts are rostered on duty over a 24 hour period, including a waking night. On each floor there are varying numbers of residents with differing levels of need. This is reflected in staffing levels. A registered nurse is always on duty on each floor, with between three to six carers during the morning and lunchtime and two to five carers in the afternoon and early evening. The home employs chefs and catering staff to provide residents meals. The home also employs a number of domestic staff, and there are usually six to seven domestic staff on duty each day from 8am to 2pm. We examined the personnel files of two care workers. These evidenced that the home obtains two satisfactory references and an enhanced Criminal Records Bureau check for staff members. Sampling of personnel files also evidenced that care workers receive copies of their employment terms and conditions. Care Homes for Older People Page 21 of 27 Evidence: The home has developed an induction programme that all staff complete. It includes safeguarding, health and safety and the gold standard framework. The home provides core training to all care staff inlcuding infection control, additional health and safety, moving and transferring and fire safety. Additional training needs are reviewed via supervision. The two care workers who we case tracked had recently received training in safeguarding, use of bedside rails, safe use of wheelchairs, infection control and understanding dementia. Over 50 of care staff has obtained NVQ level 2 or higher. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is highly competent to run the home and is an excellent role model for care staff and other employees. The manager has good people skills, provides strong leadership to staff and is responsive to the needs of residents. There is strong evidence that the ethos of the home is open and transparent, with the views of people who use the service being listened to and valued. Evidence: The manager is very experienced and qualified. They have successfully completed their NVQ level 4. The home has regular meetings with residents and relatives during which their views are sought. The manager and deputy have an open door policy, encouraging residents, relatives and visiting professionals to approach them at any time regarding concerns or issues. The homes parent organisation, BUPA produce an annual customer satisfaction Care Homes for Older People Page 23 of 27 Evidence: survey. We looked at a copy from 2009, in which the Highgate Nursing home was described by people who use it as excellent and very good. The collated surveys also contained very positive feedback relating to staff who were rated as excellent. We spoke with the manager and with people who use the service. They told us that residents are encouraged to manage their own finances. Where support is needed residents families assist with this. The home does not hold any monies for residents. We looked at the homes record of accidents and incidents. We found this to be in good order. We noted that the log was reviewed each month, and that there did not appear to be any pattern to accidents or incidents. The home has obtained appropriate insurance cover and a valid insurance was displayed. We looked at the homes fire records. These evidenced that weekly fire alarm tests are carried out and recorded. The home was also evidenced as carrying out regular checks on firefighting equipment, emergency lighting and evacuation aids. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Residents individual plans must be reviewed every month. To promote the safety and well being of people who use the service. 30/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 15 The home should provide more meals that reflect the range residents cultural backgrounds. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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